Mitterberger M, Pinggera G M, Horninger W, Bartsch G, Strasser H, Schäfer G, Brunner A, Halpern Ethan J, Gradl J, Pallwein L, Frauscher F
Departments of Urology and Radiology 2, Medical University Innsbruck, Innsbruck, Austria.
J Urol. 2007 Aug;178(2):464-8; discussion 468. doi: 10.1016/j.juro.2007.03.107. Epub 2007 Jun 11.
Prostate cancer grading with Gleason score is an important prognostic factor. This prospective randomized study compares ultrasound systematic biopsy vs contrast enhanced color Doppler targeted biopsy for the impact on Gleason score findings.
We examined 690 men (mean age 56 years, range 41 to 77) with a serum total prostate specific antigen of 1.25 ng/ml or greater, a free-to-total prostate specific antigen ratio less than 18% and/or a suspicious digital rectal examination. Contrast enhanced color Doppler targeted biopsies with a limited number of cores (5 or less) were performed in hypervascular areas of the peripheral zone during administration of the ultrasound contrast agent Sonovuetrade mark (Bracco, Milano, Italy). Ten systematic biopsies were obtained in a standard spatial distribution. Cancer detection rates and Gleason score were compared.
Prostate cancer was identified in 221 of 690 subjects (32%) with a mean prostate specific antigen of 4.6 ng/ml (range 1.4 to 35.0). Prostate cancer was detected in 180 of 690 subjects (26%) with contrast enhanced color Doppler targeted biopsy and in 166 of 690 patients (24%) with systematic ultrasound biopsy. The Gleason score of all 180 cancers detected on contrast enhanced color Doppler targeted biopsy was 6 or higher (mean 6.8). The Gleason score of all 166 cancers detected on systematic biopsy ranged from 4 to 6 and mean Gleason score was 5.4. Contrast enhanced color Doppler targeted biopsy detected significantly higher Gleason scores compared to systematic biopsy (Wilcoxon rank sum test p <0.003).
Contrast enhanced color Doppler targeted biopsy detected cancers with higher Gleason scores and more cancer than systematic biopsy. Therefore, contrast enhanced color Doppler seems to be helpful in the grading of prostate cancer, which is important for defining prognosis and deciding treatment.
采用 Gleason 评分对前列腺癌进行分级是一项重要的预后因素。本前瞻性随机研究比较了超声系统活检与对比增强彩色多普勒靶向活检对 Gleason 评分结果的影响。
我们检查了 690 名男性（平均年龄 56 岁，范围 41 至 77 岁），其血清总前列腺特异性抗原为 1.25 ng/ml 或更高，游离与总前列腺特异性抗原比值小于 18%和/或直肠指检可疑。在超声造影剂 Sonovue（意大利米兰的 Bracco 公司）注射期间，在周边区的高血管区域进行有限数量（5 个或更少）的对比增强彩色多普勒靶向活检。以标准空间分布获取 10 次系统活检样本。比较癌症检出率和 Gleason 评分。
690 名受试者中有 221 名（32%）被确诊为前列腺癌，平均前列腺特异性抗原为 4.6 ng/ml（范围 1.4 至 35.0）。690 名受试者中有 180 名（26%）通过对比增强彩色多普勒靶向活检检测出前列腺癌，690 名患者中有 166 名（24%）通过系统超声活检检测出前列腺癌。对比增强彩色多普勒靶向活检检测出的所有 180 例癌症的 Gleason 评分为 6 或更高（平均 6.8）。系统活检检测出的所有 166 例癌症的 Gleason 评分范围为 4 至 6，平均 Gleason 评分为 5.4。与系统活检相比，对比增强彩色多普勒靶向活检检测出的 Gleason 评分显著更高（Wilcoxon 秩和检验 p<0.003）。
对比增强彩色多普勒靶向活检检测出的癌症 Gleason 评分更高，且比系统活检发现的癌症更多。因此，对比增强彩色多普勒似乎有助于前列腺癌的分级，这对于确定预后和决定治疗很重要。
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